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October 16, 2019

Advances in IBS Research Target Dietary Burdens

By Advancing the Science contributor

By Sara Nick

The number one reason to miss school or work in the U.S. is the common cold. Number two? Irritable bowel syndrome (IBS), a disorder of the large intestine that can cause cramping, pain, gas, constipation, and diarrhea.

“IBS is incredibly prevalent, affecting about 1 in 7 adults,” says Mayo Clinic gastroenterologist Brian Lacy, M.D., Ph.D., who has studied the disorder for 20 years. “It can negatively impact a patient’s quality of life in all spheres such as personal relationships, leisure activities, and work.”

There is no known cure for the disorder, but Dr. Lacy and his team on Mayo’s Florida campus are studying ways to help IBS patients and their doctors make the most of available treatment options.

Brian Lacy, M.D., Ph.D.

Making an IBS diet more palatable

Strict dietary changes are one major strategy for managing IBS symptoms, and experts believe a diet known as FODMAP (an acronym referring to chemicals found in certain fruits, grains, and dairy products that IBS patients are asked to avoid) is most effective. Unfortunately, the FODMAP diet is restrictive and difficult for patients to understand.

“Most physicians don’t have time to explain this complex diet in detail, and many patients can’t afford to visit a dietician because that’s generally not covered by insurance,” says Dr. Lacy. “So it’s important for us to figure out how best to convey understandable information to patients.”

The researchers are evaluating which educational method about FODMAP will be most successful in improving patient symptoms: an in-person visit with a knowledgeable dietitian, an online video, a printed handout, or a dietician-led group.

Dr. Lacy and colleagues are also
considering ways to make the diet itself less burdensome. “Currently, the
FODMAP diet paints with a pretty broad brush, asking patients to eliminate many
different foods. Some IBS patients may be able to get away with eliminating
just a few, but it’s difficult to determine which specific ingredients are
triggering an individual’s symptoms,” he says. The scientists are working to
determine whether a blood sample taken from a quick finger prick can identify
which specific foods are posing a problem for patients. “Most IBS sufferers
need to manage the disorder for a long period of time, so being able to provide
them with more individualized recommendations could be a big help,” says Dr.
Lacy.

Finally, his team is involved
with pharmaceutical research that they hope will improve symptoms of pain and
urgency among IBS sufferers.

Advances bring hope to patients

In the past decade, Dr. Lacy has witnessed
numerous advances in IBS treatment options, which are not limited to diet
changes and new medications. For example, he notes that scientists have gained
awareness of the bi-directional pathway between the brain and the intestines —
that is, the idea that gastrointestinal (GI) disorders such as IBS can change
the brain, and that brain-related factors such as anxiety can affect the gut. “Stress
can trigger a response in the brain that can worsen IBS symptoms, and chronic
GI symptoms can turn around and exacerbate anxiety or depression,” says Dr.
Lacy.

“IBS is a complex disorder influenced by genetics, environment, diet, and culture, all of which need to be taken into account in future studies,” he says. “We’re hoping to make an IBS diagnosis easier for patients, and help primary care providers understand it a little better, too.”